Our study suggests that better adherence to statin agents is associated with a significant risk reduction of CAD. Adherence to statin agents needs to be improved so that patients can benefit from the full protective effects of statin therapies.

Purpose The aim of this cohort study was to describe the prevalence, incidence, and risk factors for thrombocytopenia in the intensive care unit (ICU) and to evaluate the impact of thrombocytopenia on mortality with further comparisons amongst major diagnostic categories. Methods Patients admitted to the ICU from 1997-2011 for cardiac, medical, surgical, and trauma conditions were included. The presence of a platelet count\ 100 9 10 9 ÁL -1 on admission day or its appearance during ICU stay were considered as prevalent and incident thrombocytopenia, respectively. Risk factors for thrombocytopenia and the influence of thrombocytopenia on mortality were also analyzed. Results This study included 20,696 patients. Prevalent and incident thrombocytopenia occurred in 13.3% and 7.8% of patients, respectively, with associated mortality rates of 14.3% and 24.7%, respectively, compared with 10.2% in the group with normal platelet count (P \ 0.001). After adjustments, thrombocytopenia remained associated with an increased risk of mortality (odds ratio 1.25; 95% confidence interval 1.20 to 1.31; P \ 0.001). The greatest impact of thrombocytopenia on mortality was observed in the cancer, respiratory, digestive, genitourinary, and infectious diagnostic categories. Independent risk factors included age, female sex, admission platelet counts and hemoglobin, mechanical ventilation, days of hospitalization prior to ICU admission, liver cirrhosis, hypersplenism, coronary bypass grafting, intra-aortic balloon pump placement, acute hepatitis, septic shock, and pulmonary embolism or deep vein thrombosis. Conclusions Thrombocytopenia in the ICU is associated with an independent risk of mortality that varies greatly depending on diagnostic admission category.Electronic supplementary material The online version of this article

82.1% initially diagnosed at stage IV. Common sites of metastasis were bone (41.1%), brain (23.2%), contralateral lung (19.0%), and liver (15.8%). 24.2% were current smokers; 67.4% past (median 38 pack years). There were no differences in these characteristics by regimen. The most common comorbidities were COPD (30.5%) and diabetes (16.8%). Most patients were from the South (56.8%) vs. Northeast (13.7%), Midwest (21.1%), and West (8.4%). Patients from the South were 3 times as likely (OR = 3.02) to receive a bevacizumab-containing regimen (Regimens B+D) than patients from the non-South regions, χ 2 = 6.5293, df = 1, p = 0.0106. ConClusions: Patients treated for advanced NSCLC in real world settings appear demographically and clinically similar to patients treated in clinical trials. Preliminary findings suggest regional differences in chemotherapeutic treatment patterns.

D espite important advances in primary prevention, atherosclerosis remains the leading cause of death in developed societies.1 In addition to risk factors such as hypertension, diabetes mellitus, tobacco use and dyslipidemia, less traditional risk factors have also been sought. Many markers, including C-reactive protein and interleukins, highlight inflammation as a key mediator in both the progression and activation of atherosclerotic lesions.2-4 Some medications that are used to prevent cardiovascular diseases, such as statins, also appear to reduce inflammation. 5 Animal experiments have shown that pneumococcal vaccination reduces the extent of atherosclerotic lesions. 6 We hypothesized that antibodies directed against Streptococcus pneumoniae also recognize oxidized low-density lipoprotein (LDL) and impede the formation of foam cells. Interestingly, a retrospective cohort study involving World War II veterans who had undergone splenectomy documented excess mortality rates from both pneumonia and ischemic heart disease. 7 More recent data have suggested that acute pneumococcal infections, but not vaccinations, increase the risk of vascular events; 8 however, the duration of vaccination exposure considered in that study was limited.Our primary objective was to evaluate the association between pneumococcal vaccination and the risk of myocardial infarction. We also explored whether any effect of vaccination on the risk of infarction waned over time. Methods Design and ethics approvalWe conducted a case-control study of patients who were considered at risk for myocardial infarction and who had been admitted to a tertiary care hospital. We obtained approval for this study from the research ethics board of the Centre hospitalier universitaire de Sherbrooke and Quebec's Commission d'accès à l'information. Data sourcesWe used 2 databases for this study. The first was the research-purpose database 9 of the Centre informatisé de recherche évaluative en services et soins de santé of the Centre hospitalier universitaire de Sherbrooke, a tertiary care teaching hospital in the province of Quebec. Along with demographic data, this database included, for each hospital admission since 1996, detailed information on all primary and secondary diagnoses, coded according to the International Classification of Diseases, 9th revision (ICD-9). This database also contained all biochemical and pharmaceutical data recorded during the admission, including, for each medication prescribed, the name, dosage, formulation, quantity dis- Pneumococcal vaccination and risk of myocardial infarctionFrom the Department of Medicine (Lamontagne, Garant, Carvalho, Lanthier, Pilon), Université de Sherbrooke, Sherbrooke, Que.; and the Department of Clinical Epidemiology and Biostatistics (Lamontagne, Smieja), McMaster University, Hamilton, Ont. CMAJ ResearchBackground: Based on promising results from laboratory studies, we hypothesized that pneumococcal vaccination would protect patients from myocardial infarction. Methods:We conducted a hospital-based ...